Interactive Transcript
0:00
This is a 40 year old female presenting for a routine baseline screening
0:07
mammogram. We can see, first of all, in this case that the technique
0:14
image quality is not that great. On both of the MLO views, we
0:18
rarely see any pectoralis muscle here on the right hand side
0:23
and virtually none on the left hand side. This would not be great
0:27
and probably recommend some additional views just for technical
0:32
quality. In this case, the patient was not very tolerant of mammographic
0:38
positioning, and so this was the best that the technologist could do.
0:43
Looking sort of globally, we see some calcifications here in the right breast.
0:48
This grouping here, and this one here and this here.
0:52
On the left side, it looks normal. Pull down just the right hand side. On
0:58
the right as we get a closer look, we'll look at this group
1:01
of calcifications here. These have more stereotypical appearance of classic
1:05
fat necrosis. Right? They're rim oriented calcifications. I see the associated
1:12
circumscribed mass with it. And the right side, again, we see that small
1:19
rim calcified mass. This is classically benign, nothing we can do about
1:23
that. Further medial in the breast, in the CC view, we see this
1:29
grouping of amorphous calcifications in quite a large group.
1:35
Measuring, let's see what we got here, maybe about two and a half centimeters
1:38
or so. On the MLO view, we see the corresponding group of calcifications
1:44
here, putting this group of calcifications in the right breast at approximately
1:48
one o'clock posterior depth. And this is a screening exam, so she got
1:52
called back for further evaluation. But let's look at the tomosynthesis
1:57
images just for completeness. As we scroll through this area, we can see
2:01
these amorphous calcifications. And amorphous means that there's not a real
2:05
distinct shape or size that we can tell.
2:09
People describe it more classically as kind of grains of sand appearance
2:13
in the mammogram. And we sort of get that sense in both of
2:17
the views. You could argue for sure in this case that there are some
2:22
associated asymmetry with these calcifications, and I would agree with that
2:25
as well. So if we didn't see these
2:30
very well, you could potentially try to find them by ultrasound if you
2:33
wanted to. It's a little bit more challenging to do, but at least
2:38
in theory possible with the associated asymmetry. But this patient ended
2:41
up getting magnified mammographic views, our standard workup for calcifications.
2:48
And again, in the medial right breast, we see these amorphous calcifications
2:51
that are really difficult to see on this view. There's probably a little
2:54
bit of motion here as well, but not easy.
2:59
Similarly, on the ML view, we see those same calcifications here.
3:03
It's clouded a little bit by the heterogeneously dense
3:07
tissue, which is making it more difficult to see these calcifications. We
3:11
can partially see that rim calcified mass we described earlier.
3:14
Regardless, these amorphous calcifications are considered suspicious. They'd
3:18
be given a BI RADS 4B and recommended for biopsy. This patient subsequently
3:24
underwent image guidance, stereotactic biopsy, and this was biopsy proven
3:28
malignancy.
© 2024 MRI Online. All Rights Reserved.